US7421061B2 - Method and medical imaging system for compensating for patient motion - Google Patents
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Definitions
- the present invention relates to a method to compensate for patient movements when recording a series of medical images in which a number of images of an area under examination of the patient are taken at intervals with an imaging system and are compared to one another, as is the case for example in Digital Subtraction Angiography (DSA) or roadmapping.
- DSA Digital Subtraction Angiography
- the invention further relates to a medical imaging system with radiation source, detector, patient support, image processing unit and image display unit which is embodied to execute the method.
- the area of digital subtraction angiography blood vessels of the human body are recorded with an imaging system, in this case an X-ray system, and displayed.
- an imaging system in this case an X-ray system
- series of X-ray images of the area under examination of interest for the patient are recorded while a contrast means is injected to highlight the vessels (filling images).
- an image of the area under investigation is recorded without injecting a contrast means (mask image).
- the subtraction of the images however requires these images to be recorded under the same geometrical conditions so that they cover the same area.
- the result can be disruptive motion artifacts in the subtracted images. These can be caused by the patient moving between the recording of the mask image and the recordings of the filling images. A consequence of these movements can be that the resulting subtraction image can no longer be used for the diagnosis.
- disrupted subtraction images have to be repeated. This often involves additional effort in time and contrast means as well as exposing the patient to additional radiation.
- a method known as roadmapping is a technique associated with digital subtraction angiography. This technique is applied for selective categorization of vessels in interventional therapy. With such vessels the current position of an X-ray-absorbing catheter is shown by X-ray fluoroscopy in a two-dimensional image.
- an image is recorded at the start of the intervention for which a small amount of contrast means has been injected. This image is retained as a mask image.
- the following fluoroscopy images obtained without injection of a contrast means are subtracted from the mask image in each case. In this way subtraction images are obtained on which the catheter is visible as a bright object against the dark blood vessel and the background has been eliminated by subtraction.
- Patient-linked solutions aim to avoid movement of the patient during image recording.
- the patient can be trained to hold their breath while the series of images is being recorded.
- a further option is to avoid a number of sources of motion artifacts by full anesthetic.
- a disadvantage of patient-linked methods lies in the fact that they are only partly effective or can-not always be used.
- a full anesthetic for example involves many risks and is thus not medically advised for many applications of digital subtraction angiography.
- a number of sources of motion artifacts, such as breath movement are still present.
- the image recording is executed so that motion artifacts are minimized.
- the main method known in this area has been the Gating method in which the recording is coupled with a physiological measurement.
- Gating methods are however only usable for a few specific applications and can only avoid motion artifacts caused by specific sources for which physiological signals can be measured.
- a further approach to a solution for avoiding motion artifacts consists of retrospective image processing of the recorded images.
- the aim is to use image processing to obtain a better match between mask image and filling image.
- the simplest technique used is known as pixel shifting or subpixel shifting, in which the user shifts the mask image in relation to the filling image manually in two dimensions until a minimization of the motion artifacts is obtained in the subtraction image.
- This method is implemented in all commercial angiography systems. Automatic methods which define the best match on the basis of quantifiable similarity measures are present in a few commercial angiography systems. More complex methods do not use global pixel shifting over the entire area of the image but optimize local areas of the image separately from one another, as described for example in U.S. Pat. No.
- Retrospective image processing can however only approximately compensate for motion. Not all motion can be corrected. Even when the method is restricted to a correction of 6 degrees of freedom corresponding to the rotation and translation of a rigid body the motion cannot be uniquely determined from the two-dimensional images. Furthermore the complicated image processing methods demand extensive processing power and are thus difficult to implement in real time. Manual methods for image processing (pixel shifting) need user interaction and can demand significant amounts of time. They can also basi-cally only be used for retrospective improvement of recorded DSA images since with roadmapping there is barely time for interaction.
- an object of the present invention is to specify a method as well as an associated imaging system to compensate for the motion of patients when recording a series of images in medical imaging, with which the motion of the patient can be compensated for while the images are being recorded without time-consuming user interaction, with the method being able to be implemented in real time.
- the method and the associated imaging system should in particular improve image results in a digital subtraction angiography and roadmapping with the lowest possible outlay as regards the operator's time.
- a localization system records a current spatial location of the area under investigation in a reference system connected to the imaging system continuously or at least close to the time at which the individual images are recorded in each case.
- a first spatial location of the area under examination recorded close to the point of recording of a first image is retained and deviations of the relevant recorded momentary images from first spatial location determined and by changing geometrical circumstances of the imaging system close to the time of recording the spatial location, preferably in real time and/or by geometrical adaptation of an image just recorded in each case are at least approximately compensated for so that the images show the area under examination in the same position and orientation in each case.
- the method can be used especially for motion compensation in digital subtraction angiography or with roadmapping to obtain individual images for subtraction which cover as much of the same area as possible. Therefore even while the images are being recorded the method compensates for patient motion or motion of the visible area of the patient under examination by a control, preferably a real-time control of the geometrical circumstances of the imaging system, where necessary in combination with geometrical adaptation of the image content.
- This involves controlling at the current spatial location of the patient or of the area under examination, that is both the current position and also the current orientation detected by a localization system, and then controlling the geometrical parameters of the imaging system so that the relative relationship between the area under examination for which the image is to be recorded and the recording system remains constant. Individual degrees of freedom can be compensated for in this case by adaptation, especially rotation or translation, of the image content of the recorded image.
- a device with which the position and orientation (a total of six degrees of freedom) of a position sensor in the three-dimensional area can be measured is preferably used as a localization system.
- these types of localization system are optoelectronic position sensors, for example OPTTRAK 3020 from Northern Digital, Waterloo, Canada, channel or electromagnetic localization systems such as those from Biosense Webster Inc., Diamond Bar, Calif., USA or the Bird sys-tem from Ascension, Milton, Vt., USA.
- Naturally other localization systems allowing recording of the spatial location of the area under examination within the space can be used.
- 3 position sensors can also be applied to an object under examination, from the spatial location of which the orientation of the examination area can also be derived.
- Optical scanning systems or similar, which operate without attaching sensors to the patient, are also possible.
- the present method by contrast with most previously known methods of motion correction, manages without interaction with the operator.
- the proposed method only requires a position sensor to be accommodated on the patient where necessary. Consequently no further user interaction is required for motion compensation.
- the principle of previous methods for retrospective image processing dictates that they only operate approximately. It is barely possible to correct large movements using these methods, and small movements can only be approximately corrected.
- the proposed method operates with high precision even for large movements, so that the need to record a mask image more than once is avoided.
- the present method also makes it possible in particular cases to dispense with sedating or anesthetizing the patient merely for the purpose of minimizing motion artifacts.
- Different components of the imaging system can be included to compensate for deviations resulting from patient movement by adapting the geometrical circumstances of the imaging system.
- This adaptation is preferably undertaken by a translation and/or rotation of the patient table in 1-3 degrees of freedom.
- the patient table is already movable with C-arm de-vices for angiography applications by motor at least in the 3 degrees of translation freedom.
- deviations can be matched by a rotation of the C-arm in RAO/LAO or cranio/caudal direction in 2 degrees of freedom.
- a detector is used which can be rotated in 1-3 degrees of freedom, so that deviations can also be compensated for by moving the detector.
- retrospective image processing methods can also be used in order to further improve the image results.
- the approximate compensation by modifying the geometrical circumstances of the imaging system can be used in this case to compensate for rough movements, while remaining small errors can be rectified by retrospective image processing.
- the present imaging system comprises at least a radiation source and a detector, a patient support, a control unit, an image processing unit and an image display unit.
- the geometrical circumstances for imaging can be modified by motor-driven movement of the patient support as well as the imaging unit, consisting of radiation source and detector opposite it.
- the outstanding feature of the imaging system is that a compensation unit is provided, which controls in real-time one or more of the components that can be modified in real time to change the geometrical circumstances of the imaging system and/or the image processing unit for geometrical adaptation of an image content of an image just recorded in each case so that the movements of a patient recorded by a localization system are at least approximately compensated for.
- the imaging system here is preferably embodied in the form of a C-arm device, with the positions of the patient table and of the C arm being able to be altered as movable components.
- FIG. 1 an example for a C-arm device as an imaging system for executing the present method
- FIG. 2 an example for calibrating the localization system in the C-arm device of FIG. 1 ;
- FIG. 3 an example for recording the first image with the first spatial location of the area under examination
- FIG. 4 an example for recording the further images as well as motion compensation.
- the present method is described below with reference to an X-ray angiography system for applications in neuroradiology.
- the method can naturally also be used in other fields in which digital subtraction angiography and/or roadmapping are employed.
- the present method can also be used with other medical imaging techniques involving having to record a series of images and relate them to one another.
- the embodiments below are typically restricted to the case of correcting the patient's head movements. Since the head can be approximately regarded as a rigid body, the motion can be restricted to the 6 degrees of freedom of the translation and rotation of a rigid body in three-dimensional space.
- the X-ray angiography system 1 for neuro-radiology, which is shown schematically in FIG. 1 , is used to record the images.
- the X-ray angiography system 1 includes a C-arm 1 a which can be rotated around two axes, to which an X-ray tube 10 and a detector 11 arranged opposite the X-ray tube are attached, an image processing unit 12 and an image display unit 13 . Furthermore this system includes the motor-driven adjust-able patient table 16 , a control unit 14 for image recording control as well as the compensation unit 15 . Rotation of the C-arm 1 a allows different projections of the area under examination of the patient supported on the patient table 16 to be recorded as two-dimensional images.
- a localization system 2 is used to record the location of the area of the patient under examination, in the present example the patient's head.
- This localization system 2 in the present example is a device with which the position and orientation of a position sensor 2 a can be measured in the three-dimensional space.
- the calibration consists of 6 parameters which describe the rotation and translation of the two coordinate systems relative to one another. Different methods are available for this type of calibration:
- One option for calibration consists of using a calibration phantom 3 , which is recorded by means of X-ray imaging from different angles, as is illustrated in FIG. 2 .
- the sensor 2 a of the localization system 2 is connected to the calibration phantom 3 .
- the fixed rela-tionships of markings 3 a on the phantom 3 which can be de-tected on the recorded X-ray images and the sensor 2 a , al-lows the spatial location of the sensor 2 a (and thereby of the coordinate system of the localization system) relative to the coordinate system of the angiography system 1 to be calculated in a step 4 .
- These relationships or calibration data are stored ( 5 ).
- a further calibration technique relates to calibration of an electromagnetic localization system.
- the transmitter could be accommodated at a point for which the position relative to the coordinate system of the angiography unit is known. In this case no further steps are necessary for the calibration.
- a marker plate could be mounted on the detector or another part of the angiography unit, for which the position is known relative to the coordinate system of the angiography unit.
- a further option without additional calibration steps consists in this case of installing the camera of the optical localization system permanently on the ceiling of the examination room.
- the calibration which is undertaken in the present example with the first technique described is required as a rule only once on installation of the system.
- the procedure for executing the present method can be seen from FIGS. 3 and 4 .
- First the sensor 2 a of the localization system 2 is fixed to the head of the patient 17 , as can be seen schematically from FIG. 3 . This can be done for example by an adhesive connection.
- the current spatial location of the sensor 2 a and thus of the head of the patient 17 is recorded automatically with the localization system 2 , i.e. without user interaction.
- This starting location, i.e. position and orientation is calculated taking into account the stored calibration data 5 in the reference system of the imaging device and the original position and—orientation are stored ( 6 ).
- the location of the sensor 2 a will be determined.
- the current location is compared to the stored initial location 6 and the change in the patient's location is determined (step 7 ) from the stored calibration data 5 and the stored initial location 6 .
- This information is transmitted to the control 14 of the angiography system 1 .
- the control 14 adapts the recording geometry 8 by controlling the drive for the patient table 16 as well as the drive for the C-arm 1 a and if nec. by controlling the image processing unit 9 such that patient motion can be compensated for.
- the mask image and the relevant filing images or fluoroscopy images can be subtracted from one another in the image processing unit 12 and the subtraction images obtained displayed on the image display unit 13 ( 1 c ).
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Abstract
Description
-
- Adapting the translation of the patient table in 3 degrees of freedom;
- Adapting the rotation of the C-arm in two directions (2 degrees of freedom); and
- Rotation of the image content of the recorded image (1 degree of freedom).
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DE102004004604.2 | 2004-01-29 |
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